Impact of Depression Severity on Patient-Reported Outcome Measures Following Multilevel Anterior Cervical Discectomy and Fusion

Elliot D.K. Cha; Conor P. Lynch; Caroline N. Jadczak; Shruthi Mohan; Cara E. Geoghegan; Kern Singh

doi:10.14444/8180

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Table 1

Patient demographics by depression severity.

Characteristic	Minimal (n = 42)	Mild (n = 32)	Moderate/Severe (n = 27)	P value*
Age (mean ± SD)	50.6 ± 11.0	48.6 ± 7.7	46.9 ± 9.9	0.297
Gender				0.897
Female	42.9% (18)	37.5% (12)	40.7% (11)
Male	57.1% (24)	62.5% (20)	59.3% (16)
BMI				0.567
< 30 kg/m²	64.3% (27)	56.3% (18)	51.9% (14)
≥30 kg/m²	35.7% (15)	43.7% (14)	48.1% (13)
Smoking Status				0.895
Nonsmoker	85.7% (36)	84.4% (27)	81.5% (22)
Smoker	14.3% (6)	15.6% (5)	18.5% (5)
Ethnicity				0.028
White	80.9% (34)	81.2% (26)	63.0% (17)
African American	11.9% (5)	6.3% (2)	0.0% (0)
Hispanic	2.4% (1)	6.3% (2)	25.9% (7)
Asian	4.8% (2)	3.1% (1)	3.7% (1)
Other	0.0% (0)	3.1% (1)	7.4% (2)
Diabetes				0.987
Diabetic	88.1% (37)	87.5% (28)	88.9% (24)
Nondiabetic	11.9% (5)	12.5% (4)	11.1% (3)
ASA Classification				0.159
≤2	80.4% (21)	90.6% (20)	95.8% (23)
>2	19.5% (8)	9.4% (3)	4.2% (1)
CCI				0.159
≤1	52.5% (33)	69.0% (20)	74.1% (20)
>1	47.5% (19)	31.0% (9)	25.9% (7)

^* P value calculated using analysis or Student’s t test.
Boldface indicates statistical significance.
ASA, American Society of Anesthesiologists; BMI, body mass index; CCI, Charlson Comorbidity Index.

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Table 2

Perioperative characteristics by depression severity.

Characteristic	Minimal (n = 42)	Mild (n = 32)	Moderate/Severe (n = 27)	P value*
Spinal pathology
Herniated nucleus pulposus	85.7% (36)	90.6% (29)	85.2% (23)	0.510
Spinal stenosis	57.1% (24)	65.6% (21)	66.7% (18)	0.655
Myeloradiculopathy	92.8% (39)	81.2% (26)	88.9% (24)	0.578
Number of operative levels				0.590
Single	64.3% (27)	53.1% (17)	55.6% (15)
Multilevel	35.7% (15)	46.9% (15)	44.4% (12)
Operative time, min, mean ± SD	47.2 ± 87.1	63.5 ± 19.3	54.4 ± 18.2	0.489
Estimated blood loss, mL, mean ± SD	31.7 ± 14.8	26.3 ± 9.4	30.8 ± 12.9	0.202
Length of stay, h, mean ± SD	13.0 ± 9.9	13.1 ± 14.2	12.5 ± 15.4	0.981
Day of discharge				0.138
POD0	71.4% (30)	81.3% (26)	80.0% (20)
POD1	26.1% (11)	9.4% (3)	16.0% (4)
POD2	2.3% (1)	9.4% (3)	0.0% (0)
POD3	0.0% (0)	0.0% (0)	4.0% (1)

^* P value calculated using analysis or Student’s t test.
POD, postoperative day.

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Table 3

Postoperative improvement by depression severity and number of levels fused.

PROM	Minimal Mean ± SD (n)	Mild Mean ± SD (n)	Moderate/Severe Mean ± SD (n)	P value*	P value†
VAS neck
Preoperative	4.7 ± 2.4 (40)	6.5 ± 2.1 (30)	7.4 ± 2.3 (27)	<0.001	-
6 wk	3.0 ± 2.6 (38)	3.4 ± 2.4 (30)	3.6 ± 2.7 (24)	0.292	0.789
12 wk	1.9 ± 2.3 (32)	3.3 ± 2.2 (24)	3.6 ± 2.5 (21)	0.012	0.172
6 mo	2.1 ± 2.5 (28)	3.1 ± 2.2 (22)	2.9 ± 2.8 (19)	0.251	0.629
1 y	2.4 ± 2.3 (15)	3.0 ± 2.9 (9)	4.4 ± 3.5 (7)	0.143	0.554
VAS arm
Preoperative	5.0 ± 2.6 (40)	6.6 ± 2.2 (30)	6.9 ± 2.6 (27)	0.002	-
6 wk	2.0 ± 2.3 (38)	3.2 ± 2.8 (30)	3.8 ± 5.2 (24)	0.031	0.326
12 wk	3.3 ± 3.7 (32)	2.3 ± 2.4 (24)	3.5 ± 3.4 (21)	0.824	0.231
6 mo	2.9 ± 3.7 (28)	3.1 ± 2.4 (22)	3.3 ± 3.4 (17)	0.693	0.991
1 y	3.0 ± 3.0 (15)	3.0 ± 3.3 (9)	7.0 ± 3.8 (7)	0.031	0.029
NDI
Preoperative	25.7 ± 16.5 (40)	41.4 ± 17.0 (30)	50.5 ± 15.8 (27)	<0.001	-
6 wk	23.5 ± 18.8 (38)	35.1 ± 17.7 (30)	35.4 ± 20.1 (24)	0.009	0.074
12 wk	17.7 ± 17.2 (32)	29.9 ± 18.1 (24)	35.5 ± 24.5 (21)	0.001	0.034
6 mo	17.7 ± 20.4 (28)	24.0 ± 14.5 (22)	22.2 ± 23.3 (17)	0.388	0.755
1 y	16.5 ± 16.3 (15)	20.8 ± 22.8 (9)	20.2 ± 20.7 (7)	0.621	0.969
SF-12 PCS
Preoperative	39.0 ± 9.1 (41)	34.7 ± 7.4 (32)	31.8 ± 6.7 (27)	<0.001	-
6 wk	36.9 ± 9.3 (34)	33.1 ± 5.3 (28)	33.3 ± 6.8 (23)	0.062	0.172
12 wk	41.2 ± 10.1 (26)	39.1 ± 7.3 (21)	35.0 ± 8.4 (17)	0.019	0.216
6 mo	43.6 ± 10.8 (24)	40.6 ± 9.1 (20)	36.6 ± 10.3 (12)	0.038	0.417
1 y	46.4 ± 8.0 (17)	47.6 ± 7.7 (9)	41.2 ± 15.7 (8)	0.254	0.524
1SF-12 MCS
Preoperative	55.2 ± 10.4 (41)	45.6 ± 8.6 (32)	33.4 ± 11.5 (27)	<0.001	-
6 wk	55.3 ± 9.5 (34)	49.0 ± 11.3 (28)	43.4 ± 12.4 (23)	<0.001	0.003
12 wk	57.4 ± 8.5 (26)	50.6 ± 9.1 (21)	39.6 ± 13.7 (17)	<0.001	< 0.001
6 mo	57.8 ± 7.8 (24)	45.1 ± 10.5 (20)	42.7 ± 14.1 (12)	<0.001	0.001
1 y	57.0 ± 8.9 (17)	53.8 ± 5.9 (9)	43.9 ± 16.3 (8)	0.006	0.025
PROMIS PF
Preoperative	42.9 ± 7.6 (42)	37.4 ± 6.2 (32)	35.4 ± 4.9 (27)	<0.001	-
6 wk	43.2 ± 7.1 (33)	38.0 ± 7.6 (23)	41.0 ± 6.1 (17)	0.147	0.038
12 wk	47.8 ± 12.1 (20)	44.6 ± 4.7 (20)	40.9 ± 9.5 (12)	0.046	0.372
6 mo	49.3 ± 8.0 (23)	42.5 ± 9.4 (14)	44.5 ± 8.4 (10)	0.070	0.145
1 y	49.3 ± 6.1 (16)	48.0 ± 8.3 (13)	45.3 ± 6.1 (9)	0.180	0.347

* P values calculated using linear regression to assess outcomes between Patient Health Questionnaire-9) severity groups.
†P values calculated using multiple linear regression to assess the impact of both preoperative Patient Health Questionnaire-9 severity and multilevel procedures on postoperative outcomes.
Boldface indicates significance.
NDI, Neck Disability Index; PROM, patient-reported outcome measure; PROMIS PF, Patient-Reported Outcome Measurement Information System physical function; SF-12 MCS, 2-Item Short Form Mental Composite Summary; SF-12 PCS, 12-Item Short Form Physical Composite Summary; VAS, visual analog scale.